Photobiomodulation Therapy (PBMT) is Feasible and Acceptable in Pre-conditioning and Post-operative Recovery of Patients after Total Knee arthroplasty (TKA): A Clinical Case Series

Abstract

Photobiomodulation therapy (PBMT) for minimal to moderate Kellgren and Lawrence grade knee osteoarthritis has significant evidence for effectiveness. The effect of PBMT in severe grades of osteoarthritis is less clear; and no studies have investigated the effect of PBMT before and after knee replacement surgery. This small study (n=4) aimed to understand the potential feasibility of undertaking a future randomised controlled clinical trial of a self-administered, home-based light patch system before and after total knee arthroplasty (TKA) The PBM device (450nm (6.75 mW/cm2) and 640nm (2.25 mW/cm2); 33kHz frequency, 4.5 J/cm2 radiant exposure) was self-applied by patients daily for 30 minutes for one week before, and 3 times in the week following hospital discharge after TKA. We measured numeric pain ratings, physical function and patient-reported outcomes at baseline one week prior to surgery, the day prior to surgery, at Day 4 after surgery, and at 1, 2, 4 and 6 weeks after hospital discharge. The study protocol and methods were found to be feasible and acceptable to participants. No pain was reported by any participants at 6-week follow-up. Functional measures of timed-up-and-go and 30 second chair stands test demonstrated marked improvement over the study period. No patients were requiring opioid analgesia at 6-week follow-up. Limitations included lack of gender diversity, the small number of participants and absence of information about post-hospital discharge opioid analgesic requirements from control group. The results provide confidence in progressing this research in an adequately powered, placebo-controlled, randomised clinical trial.